Healthcare Provider Details

I. General information

NPI: 1588319768
Provider Name (Legal Business Name): DEBOARH SNIDER CCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 9TH ST E #23
KETCHUM ID
83340
US

IV. Provider business mailing address

PO BOX 5621
KETCHUM ID
83340
US

V. Phone/Fax

Practice location:
  • Phone: 208-471-8530
  • Fax:
Mailing address:
  • Phone: 847-894-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: